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[[File:Single Leg Balance.jpg|thumb|Single Leg Balance]] |
[[File:Single Leg Balance.jpg|thumb|Single Leg Balance]] |
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=Mechanism of Injury= |
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[[File:Figure 7. A complex labral tear. An arthroscopic probe is seen at the junction of the labrum and acetabular rim..png|thumb| A complex labral tear. An arthroscopic probe is seen at the junction of the labrum and acetabular rim.]] |
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It is estimated that 75% of acetabular labrum tears have an unknown cause <ref>Lewis, C., & Sahrmann, S. (2006). Acetabular Labral Tears. Physical Therapy, 86(1), 110 - 121.</ref>. Tears of the labrum have been credited to a variety of causes such as excessive force, [[hip dislocation]], capsular hip hypermobility, [[hip dysplasia]], and hip degeneration <ref>Lewis, C., & Sahrmann, S. (2006). Acetabular Labral Tears. Physical Therapy, 86(1), 110 - 121.</ref>. A tight [[iliopsoas]] tendon has also been attributed to labrum tears by causing compression or traction injuries that eventually lead to a labrum tear <ref>Smith, M., Panchal, H., Ruberte, R., & Sekiya, J. (2011). Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. The American Journal of Sports Medicine, 39, 103S-110S.</ref>. Most labrum tears are thought to be from gradual tear due to repetitive [[microtrauma]] <ref>Lewis, C., & Sahrmann, S. (2006). Acetabular Labral Tears. Physical Therapy, 86(1), 110 - 121.</ref>. Incidents of labrum tears increase with age, suggesting that they may also be caused by deterioration through the aging process <ref>Lewis, C., & Sahrmann, S. (2006). Acetabular Labral Tears. Physical Therapy, 86(1), 110 - 121.</ref>. Labrum tears in athletes can occur from a single event or recurring trauma <ref> Rylander, L., Froelich, J., Novicoff, W., & Saleh, K. (2010). Femoroacetabular impingement and acetabular labral tears. Orthopedics, 33(5), 342-350 </ref>. Running can cause labrum tears due to the labrum being used more for weight bearing and taking excessive forces while at the end-range motion of the leg; hyperabduction, hyperextention, [[hyperflexion]], excessive [[external rotation]] <ref> Rylander, L., Froelich, J., Novicoff, W., & Saleh, K. (2010). Femoroacetabular impingement and acetabular labral tears. Orthopedics, 33(5), 342-350 </ref>. Sporting activities are likely causes, specifically those that require frequent lateral rotation or pivoting on a loaded femur as in [[hockey]] or [[ballet]] <ref>Lewis, C., & Sahrmann, S. (2006). Acetabular Labral Tears. Physical Therapy, 86(1), 110 - 121.</ref>. Constant hip rotation places increased stress on the capsular tissue and damage to the [[iliofemoral ligament]]. This in turn causes hip rotational instability putting increased pressure on the labrum <ref> Rylander, L., Froelich, J., Novicoff, W., & Saleh, K. (2010). Femoroacetabular impingement and acetabular labral tears. Orthopedics, 33(5), 342-350 </ref>. |
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[[File:Fouetee.jpg|thumb|Frequent pivoting on a loaded femur as in ballet is a common mechanism for labrum tears in athletes <ref> Rylander, L., Froelich, J., Novicoff, W., & Saleh, K. (2010). Femoroacetabular impingement and acetabular labral tears. Orthopedics, 33(5), 342-350 </ref>. Fouetee]] |
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Traumatic injuries are most commonly seen in athletes who participate in contact or high impact sports like football, soccer, or golf <ref>Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013</ref>. The prevalence rate for traumatic hip injuries that causes a tear of the labrum is very low. Less than 25% of all patients can relate a specific incident to their torn labrum, however they are often a result of a dislocation or fracture <ref>Mason, J. Bohannon MD. "Acetabular Labral Tears In The Athlete." Clinics In Sports Medicine. 20.4 (2001): 779-788. Web. 16 Oct. 2013.</ref>. Falling on one’s side causes a blunt trauma to the greater trochanter of the femur. Since there is very little soft tissue to diminish the force between the impact and the [[greater trochanter]], the entire blow is transferred to the surface of the hip joint <ref>Byrd, J.W. Thomas. "Lateral Impact Injury." Clinics In Sports Medicine. 20.4 (2001): 801-815. Web. 16 Oct. 2013</ref>. And since bone density does not reach its peak until the age of 30, hip traumas could result in a fracture <ref>Byrd, J.W. Thomas. "Lateral Impact Injury." Clinics In Sports Medicine. 20.4 (2001): 801-815. Web. 16 Oct. 2013</ref>. Tears of the hip labrum can be classified in a variety of ways, including [[morphology]], [[etiology]], location, or severity <ref>Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2, 105-117.</ref>. |
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===Hip Dysplasia=== |
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Anatomical modifications of the femur and or hip socket cause a slow build up of damage to the cartilage. Femur or acetabular dysplasia can lead to femoral acetabular impingement also known as FAI <ref>Rahman, Abdel, Sathish Rajasekaran, and Haron Obaid. "MRI Morphometric Hip Comparison Analysis of Anterior Acetabular Labral Tears." Skeletal Radiol. (2013): 1246-1252. Web. 17 Oct. 2013</ref>. Impingement occurs when the femoral head rubs abnormally or its lacks a full range of motion in the acetabular socket <ref>Rahman, Abdel, Sathish Rajasekaran, and Haron Obaid. "MRI Morphometric Hip Comparison Analysis of Anterior Acetabular Labral Tears." Skeletal Radiol. (2013): 1246-1252. Web. 17 Oct. 2013</ref>. There are 3 different forms of [[FAI]]. The first form is caused by a cam-deformity where extra bone is present on the [[femoral head]], which leads to the head being non-spherical <ref>Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013</ref>. The second deformity is referred to as a pincer deformity and it is due to an excess growth of the acetabular socket <ref>Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013</ref>. The third type of FAI is a combination of the first two deformities. When either abnormality is present, it changes the position the femoral head sits in the hip socket. The increased stresses that the femur and or acetabulum experience may lead to a fracture of the acetabular rim or a detachment of the overstressed labrum <ref>Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013</ref>. |
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[[File:External Rotation at the pelvic girdle.JPG|thumb|Females are more succeptable to acetabulum labrum tears due to their unique pelvic anatomy.]] |
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==See also== |
==See also== |
Revision as of 23:11, 21 November 2013
Acetabular labrum | |
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Details | |
Identifiers | |
Latin | labrum acetabuli |
TA98 | A03.6.07.008 |
TA2 | 1880 |
FMA | 43521 |
Anatomical terminology |
The acetabular labrum (glenoidal labrum of the hip joint or cotyloid ligament in older texts) is a ring of cartilage that surrounds the acetabulum (the socket of the hip joint). The anterior portion of the labrum is most vulnerable when the labrum tears.
Its function is to deepen the acetabulum, making it more difficult for the head of the femur to slip out of place (subluxation of the femur).
Regional
In the United States acetabular labrum tears usually occur in the anterior or anterior-superior area, possibly due to a sudden change from labrum to acetabu lar cartilage [1]. The most common labrum tears in Japan are in the posterior region, likely due to the customary practice of sitting on the floor [2]. Posterior labrum tears in the Western world usually occur when a force drives the femoral head posteriorly which transfers shear and compressive forces to the posterior labrum [3].
Rehabilition
With physical therapy, there is only a small amount of evidence on rehabilitation techniques for the acetabular labrum [4] It is even thought that physical therapy could be controversial due to there not being any evidence of a specific effective therapy routine [5] There are, however, some studies that report physical therapy could benefit the patient by bringing them back to “sports-ready” capabilities [6] It is advised that physical therapists keep up on the new findings and stay in close contact with the orthopaedic surgeon so they have the best idea of how to approach their patient’s case [7] Following surgery, crutches will be used for up to six weeks and there should be no expectation to return to activities such as running for at least a period of six months [8]
Some things to note when rehabilitation occurs is that it is important to know the size and placement of the tear. There are usually four phases in the rehabilitation process noted as: “Phase I – initial exercises (weeks 1-4), Phase II – intermediate exercises (weeks 5-7), Phase III – advanced exercises (weeks 8-12), and Phase IV – return to sports (weeks 12+)” [9] All physical therapy regimens should be individualized from person to person based on all adequate criteria [10]
In phase I of the rehabilitation process the first objective is to minimize the pain and inflammation. It is important to begin conducting small motion exercises that have up to 50% weight bearing capacity by the patient. A symmetrical gait pattern is imperative as not to create an imbalance in the muscles of the hip. Aquatic therapy is highly encouraged and looked upon due to its ability to help the patient move more freely without the pressure of gravity. To progress to phase “II” of the rehabilitation process patients should be able to complete straight leg raises while laying on their side to strengthen the sartorius and tensor fasciate latae muscles to build support in the leg.
In phase “II” the physical therapist should be trying to promote more flexibility in the soft tissue. There should be more emphasis on the beginning aspects of strength training while adding some resistance over time. In order to progress to phase “III”, the patient should be able to demonstrate a normal gait pattern and minimal pain with exercises like the single leg bridging to help strengthen the hamstring muscles to help with leg equality.
In phase “III” the focus is to begin building functional strength. Movements should include single leg exercises to build the muscle and challenge the strength of the hip.
In order to progress to phase “IV” the flexibility of the patient should be adequate. Phase IV is the final stage in which the physical therapist would assess and prescribe any further exercise up until the patient is ready to return to the sport [11]
Usually the therapist would start using complex movements like squatting, kicking, and running. The therapist would look for symmetrical movements on both sides of the body without pain. If the patient demonstrates the symmetrical movements without pain, the physical therapist would use their discretion for the patient’s clearance.
Some things to avoid from while rehabilitating are sitting with “knees lower than the hips, legs crossed where hip is rotated, and sitting on the edge of the seat and contracting the hip flexor muscles [12]
See also
- ^ Smith, M., Panchal, H., Ruberte, R., & Sekiya, J. (2011). Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. The American Journal of Sports Medicine, 39, 103S-110S.
- ^ Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2, 105-117.
- ^ Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2, 105-117.
- ^ Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. 2(4), 241-250.
- ^ Groh, Megan M. & Herrera, Joseph. (2009). A comprehensive review of hip labral tears. Musculoskeletal Medicine. 2(2), 105-117.
- ^ Lewis, Cara L. & Sahrmann, Shirley A. (2006). Acetabular Labral Tears. Journal of the American Physical Therapy Association. 86, 110-121.
- ^ Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. 2(4), 241-250.
- ^ Clohisy, John C. & McClure, Thomas. (2005). Treatment of Anterior Femoroacetabular Impingement with Combined Hip Arthroscopy and Limited Anterior Decompression. Iowa Orthopaedic Journal. 2, 164-171.
- ^ Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. 2(4), 241-250.
- ^ Hunt, Devyani, Clohisy, John, Prather, Heidi. (2007). Acetabular Labral Tears of the Hip in Women. Physical Medicine and Rehabilitation Clinics of North America. 18(3), 497-520.
- ^ Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. 2(4), 241-250.
- ^ Lewis, Cara L. & Sahrmann, Shirley A. (2006). Acetabular Labral Tears. Journal of the American Physical Therapy Association. 86, 110-121.